Leukocyte count may predict COVID-19 severity in postmenopausal women

Leukocyte count may predict COVID-19 severity in postmenopausal women | Image Credit: © Tomas Ragina - © Tomas Ragina - stock.adobe.com.

Predicting the severity of COVID-19 infection may be improved through leukocyte, also known as white blood cell count, according to a recent study published in Menopause, the journal of The Menopause Society.¹

COVID-19 has impacted millions of individuals worldwide, with 70% of COVID-19 patients presenting with cognitive impairment after infection. The risk of cognitive impairment is significantly increased among older adults, especially women.¹

“Although health care professionals know a lot more about COVD-19 than they did at the start of the pandemic in 2020, there are still many lingering questions regarding its effect on the human body,” wrote The Menopause Society. To fill this gap in knowledge, investigators conducted a study evaluating the association between leukocyte and COVID-19 disease outcomes.¹

Baseline data was collected by the Women's Health Initiative (WHI) from 1993 to 1998.² Participants included postmenopausal women aged 50 to 79 years who completed a WHI baseline assessment. This evaluation was performed to obtain characteristics such as demographics, clinical characteristics, medical history, and medication use.

Between June 2021 and February 2022, participants completed a COVID-19 survey with items on post-acute sequelae of severe acute respiratory coronavirus 2 (PASC)-related symptoms. COVID-19 testing and results data was also reported in the survey.²

Respondents reporting at least 1 positive COVID-19 test were asked to report which symptoms they experienced and symptom duration. Blood samples of participants were obtained during the WHI baseline visit after a 12-hour fasting period. Available leukocyte count at baseline was reported in approximately 160,000 participants.²

PASC outcomes were defined using data from the WHI survey. PASC was reported as a binary variable based on the self-report of at least 1 COVID-19 symptom lasting for 8 weeks or longer. Secondary outcomes included a binary PASC severity and a continuous PASC severity.²

Having 1 or more PASC symptom was reported in 35.6% of patients. Memory problems, difficulty thinking or concentrating, and brain fog were reported in 12.7%, 11.1%, and 11.6%, respectively. Additionally, of patients with PASC symptoms, 74.8% reported 2 or more, with a mean number of 3.70 symptoms.²

Younger age and increased odds of having smoked or be taking menopausal hormonal therapy were reported in women with PASC symptoms. Being vaccinated for COVID-19, having received COVID-19 specific therapies, and having experienced severe COVID-19 were also more common in these patients.²

No association was reported between high-sensitivity C-reactive protein concentrations and PASC outcomes. However, leukocyte count was linked to the number of PASC symptoms, despite not being linked to other PASC outcomes.²

Specifically, loge-transformed leukocyte count at baseline was positively correlated with the sum of PASC symptoms as reported in the COVID-19 survey. When adjusting for covariates, model 1 had a 95% confidence interval of 0.17 to 0.56, vs 0.07 to 0.47 for model 2 and 0.002 to 0.40 for model 3.²

These results indicated leukocyte count as an independent predictor of COVID-19 symptom severity among postmenopausal women.¹ Additionally, the data highlights a potential role of low-grade inflammation as a precedent for acute COVID-19 infection.

“As the authors highlight, post-acute sequelae of severe acute respiratory coronavirus 2 infection significantly affects quality of life, often leading to severe disability,” said Monica Christmas, MD, associate director of The Menopause Society.¹

“By understanding underlying factors, we can better address these challenges and work to mitigate the cascade of symptoms that follow,” Christmas added.¹

References

1. White blood cell count could predict severity of COVID-19 symptoms. The Menopause Society. January 28, 2025. January 29, 2025. https://menopause.org/press-releases/white-blood-cell-count-could-predict-severity-of-covid-19-symptoms
2. NG TKS, Beydoun HA, Von Ah D, et al. Pre-pandemic leukocyte count is associated with severity of post-acute sequelae of SARS-CoV-2 infection among older women in the Women's Health Initiative. Menopause. 2025;32(3). doi:10.1097/GME.0000000000002490